Blog

Featured

Underweight and Underrepresented: The Cardiac Complications of Disordered Eating

We get it. Being overweight is bad for you. Extra weight strains the heart, forcing it to work harder, consequently raising your blood pressure and increasing your risk of myocardial infarction, cardiomyopathies, and stroke. Spending your days on the couch binge-watching Grey’s Anatomy probably isn’t the best lifestyle choice, and a diet of salty, trans-fat-fried carbohydrates cannot possibly be good for you. You do need some exercise to strengthen your heart, and fruits and vegetables are a nutritional necessity, but that’s common knowledge; we all know that already. So, let’s discuss something different; let’s discuss the other extreme–severe emaciation, caloric restriction, and compulsive purging. Underweights are underrepresented by/in the cardiovascular health community, and thusly, I have taken it upon myself to educate you on this equally unhealthy lifestyle.

Bradycardia and hypotension are the two most common cardiac complications of anorexia. In an endeavor to conserve energy, the body begins to shut down, slowing the heart rate and consequently lowering the blood pressure; neither matter is helped by nutritional irregularities/deficiencies (such as B-12, iron, magnesium). Both bradycardia and hypotension are generally benign, but prolonged cases of each can result in confusion, dizziness, fainting, fatigue, heart failure, and tissue death. Many bradycardic and hypotensive patients notice spikes in their heart rate and blood pressure when they stand up; some even experience palpitations, lightheadedness, and collapse. And that’s just standing–imagine what exercise can do!

Exercise in and of itself cannot cause a heart attack, but it can trigger one. The stress on your heart can induce palpitations, arrhythmias, arterial spasms, sudden cardiac death, and, yes, a heart attack. This exercise, while it should strengthen your heart, ends up weakening it because of the atrophic nature of muscles during starvation; you break down the muscle without giving it the energy it needs to build up again. Do I really need to tell you how dangerous this is?

This brings me to the second half of my post, the nutritional component. When deprived of nutrients, the body starts to eat itself. Contrary to popular belief (read: diet industry propaganda), fat is not the first thing to go; on account of their nutritional density, muscles are devoured, and the heart, as one of the largest muscles, is a natural victim. You can literally eat your heart out.

This catastrophic self-consumption leads to many dire results, including mitral valve prolapse, the flopping of the mitral valve, where its flaps collapse and allow for valvular leakage and regurgitation, eventually leading to arrhythmias, left ventricular enlargement, strokes, and heart attacks. Self-consumption is premised by malnutrition, an incredibly harmful state in its own right. A caloric deficit is also a nutritional deficit, since calories are not just energy, but couriers, carrying vital vitamins and minerals, including essential electrolytes. Electrolytes are necessary for heart function, as the heart’s de- and repolarisation is facilitated by ionic channels. A severe shortage of electrolytes can have immediate results like life-threatening cardiac arrhythmias; these, including the frequently fatal ventricular fibrillation, can cause cardiac arrest and, in rare instances (represent!), a heart attack. Consequences can be lasting as well, with electrolyte deficiencies yielding permanent extrasystoles (both atrial and ventricular, including various varieties of geminy) and Long QT Syndrome, the latter of which predisposes one to chaotic heartbeats, and in turn, heart attacks and/or cardiac arrests. It is also worth noting that heart attacks do permanent damage to the myocardial muscle, creating eventual and incurable cardiomyopathies.

Additionally, many underweight individuals are susceptible to vicious binge/purge cycles. A binge’s rapid influx of calories can cause systemic shock, manifesting as cardiac arrest, and self-induced emesis can do the same, with dehydration and the abrupt loss of electrolytes rendering similar effects. The cardiac complications of anorexia can be fatal, and if you are lucky enough to escape them, you are still susceptible to recovery-occurrent ones such as refeeding syndrome, a type of systemic shock analogous to that of a binge. Sounds fun, right?

Please do not do this to yourself. Maintain a healthy weight, eat a balanced diet, and exercise in moderation! Your body will thank you.

National Frozen Yogurt Day

“Food holidays” are a rather contentious topic in the eating disorder recovery community. Some people see these occasions–specific calendar days given over to the celebration (and consequent consumption) of certain food items–as detrimental, arguing that they promote binge eating and/or facilitate restriction. I can certainly see this side of the matter; one could binge on the designated food and/or “carb-load” (restrict carbohydrates to “justify” a future surplus) in preparation for the day. A case could also be made that such events sabotage intuitive eating; they could theoretically create a sense of obligation where a patient feels they have to celebrate–that they have to eat the special food on the special day–or conversely, that they can only eat the special food on the special day. These points are valid, and I completely understand where the dissenters are coming from; this just hasn’t been by experience at all.

I, for one, find these “food days” to be extremely beneficial. In recovery from anorexia, it is very easy to get stuck in an limited diet of “safe foods”, and at the very least, these occasions offer variety. They present the perfect opportunity to conquer a fear food in a structured setting; in fact, they may very well be the push you need to move forward in your recovery in that regard. Additionally, such holidays acquaint you with new food items, which, in addition to providing personal enjoyment, nourish your body with a differing array of micronutrients, contributing thereby to an overall healthier nutritional profile.

By no means am I suggesting that you celebrate every food holiday in existence with a jumbo portion of whatever the occasion calls for. No! In fact, I’m not suggesting anything. I’m just sharing my personal experience and encouraging you to find what works for you. Maybe that’s food holidays, maybe it’s not. Talk it over with your treatment team and decide from there. For now, though, I’m going to celebrate NATIONAL FROZEN YOGURT DAY!

Making Pancakes on a Sunday Morning

You’ll wake up one morning, and you’ll be really, bizarrely hungry. You’ll yawn, rub your eyes, and contemplate going back to sleep. But you won’t; you’ll swing your legs out of bed and slippers half-on you’ll wander into the kitchen. Without a second thought, you’ll start making pancakes, greasing the pan with butter and adding extra chocolate chips. You’ll flip them, and it’ll feel so easy, so fun. They’ll fly through the air, and you’ll laugh as they land on the stove with a plop. You’ll have to put them back in the pan and wait a couple minutes. The edges will turn golden-brown, and you’ll switch off the stove. You’ll finally find that syrup in the back of your cabinet, and you’ll open it for the first time in years. It’ll all spill out, too much, but you won’t really care. You’ll just dip your finger in it, and you’ll realize that this, this is what recovery tastes like.

Ingredients:

  1.  1 1/2 cups all purpose flour
  2. 2 eggs
  3.  3/4 cup blueberries
  4. 1 cup milk
  5. 3 tablespoons melted butter OR mildly flavoured (I recommend either vegetable or canola, but coconut can be substituted if necessary) oil, extra for greasing and garnish
  6. 1 1/2 tablespoons vanilla extract
  7. 1 3/4 tablespoons sugar
  8. 2 teaspoons baking powder
  9. 3/4 teaspoon salt
  10. Maple syrup, optional, to taste

Preparation:

  1. In a large bowl, combine flour, baking powder, and salt. Mix thoroughly and set aside.
  2. In a smaller bowl, combine the eggs, vanilla, and milk. Whisk well.
  3. Combine the contents of the two bowls. Stir until the batter is uniform.
  4. Add blueberries.
  5. Heat a griddle or large frying pan to medium heat. Grease it with butter or oil so that the pancakes do not stick to it.
  6. In approximately 1/4 cup portions, ladle the batter onto said pan.
  7. Let the pancake cook for approximately two minutes or until golden brown on the bottom.
  8. Flip your pancake and cook for another 2 to 2 1/2 minutes.
  9. Repeat steps 6-8 until you run out of batter.
  10. Serve pancakes with butter and syrup.
  11. Enjoy!

A Walk Down Wardour Street on a Late December Evening

Note: I set out to write a cheery Christmas vignette, but this is anything but! The following post, an account of a past Christmas, contains mature themes, disturbing imagery, mentions of suicide, descriptions of eating disorder thoughts, and “sick photos”. If you are easily triggered, please exercise caution when reading. Thank you, and have a very Happy Christmas.

There were lights on lamp-posts. They flickered—on and off, on and off. Were they dying, too? Blurry through the haze. And they were barely visible now, hard to see; hard to keep her eyes open, she could hardly breathe. But really, they were just lights, lights in the darkness, what was there to see? Incandescent and rainbow, festive and free.

And there were pies in the windows—tiny, white, dusted with powdered sugar, filled to the brim with fruit—with apples, with cherries, with blackberries, with pumpkin, with rhubarb, with mince meat—with pecans, with chocolate, with creams… Should she get one? A smile cracked her lips, ripping through her cheeks, shredding like scissors on wrapping paper, and a laugh clogged her throat—a gurgling sound, a gravelly sort of choking. Was she gagging, asphyxiating? And my god, she couldn’t breathe. It was the thought—the thought of it, the sheer ludicrousity of it, the misery; it was just so funny, so funny that it was killing her. But she had to get going now; she really had to keep walking.

The pies could keep leering at her through the bakery windows for all she cared. She really had to get going; she really had to keep walking. She really wanted one, though; yes, she really did want one. But no, it was fine; she was fine. And no, no, she would not be getting one. Besides, she only needed to see them to taste them, smell them to feel them—in her mouth, against her teeth, down her throat, sitting in her stomach, squatting in her skin, boiling in her blood, infiltrating her cells, turning to fat. So no, no, she would not be getting one.

And there was tinsel on the roofs. She could see it despite the darkness. It was hanging, hanging, hung—silver and sparkly, limp but lovely. Oh how she wanted to take a piece! She could wrap it around her neck, drape it like a scarf, pull it tight and feel the warmth, tie it to a hook, hear a crack and feel the pain until—thank god!—she couldn’t breathe. Well, it was dark inside, too, she supposed.

And there was music in the shops. Tambourines tinkled as jingle bells jingled. Shop doors opened, spewing music, spitting warm air into the cold—yes, the cold, the bitter, biting cold; she could feel it in her bones, taste it in her lungs—was that why she couldn’t breathe?—, hear it in her ears—a popping, a pressure, a pain, a pleasure. There was a heaviness to it, to the music, to how it sat in her ears and how it sunk there; it gave her that airplane kind of feeling—the one you get when you take-off or land (when the cabin pressure changes), the one you have to chew gum to get rid of. But gum has calories, you know.

And there was snow on the sidewalk. Legions of boots stamped through it, leaving lesions on the pavement, letting crusty, brown blood ooze from their scars. The wind whipped them over, beating them like frosting for a cake, concealing them from view; the flakes fell down again, and instantly they were cadavers covered in sheets, those hospital corpses that no one had claimed—hidden from view, under a blanket, yet still so very, very there. She wondered vaguely where they went, the footprints in the snow, but it didn’t matter. She just kept walking, her shoes slapping the sludge, sinking a little deeper into the spoils they had made. It was too cold out, and the snow looked too much like powdered sugar. She didn’t want to breathe it in; it might make her hungry.

And there was a girl in the middle of Wardour Street, standing on the edge of the sidewalk, too close to the cars. She was waiting for one of them to hit her, watching with bated breath as they passed her by. Snow fell all around her, and the wind threw her from side to side; she was a puppet on their string, a statuette of sticks, stuck together with the stuff of nightmares. A clock chimed through the darkness, and her heart skipped a beat. It was Christmas time in London, the perfect time to die.

Heart Health and the Holidays

‘Tis the season for gingerbread, candy canes, presents, snowmen, joy, good cheer… and, apparently, heart attacks! Yes, according to the American Heart Association, more heart attacks occur during the holidays than any other time of year (with Christmas logging the most heart attacks per day annually!). Take extra good care of your heart this year and make your holiday one of stories not statistics. Read on to find out how:

  • Stay warm: When it’s cold, your arteries constrict to preserve heat; the flow of oxygenated blood to and from the heart is thusly decreased, forcing the heart muscle to work harder. Sudden temperature changes (e.g. stepping out into the cold or participating in the polar plunge) can trigger a heart attack in predisposed persons. Additionally, prolonged exposure to the cold can result in frostbite and/or hypothermia, causing tissue death and even freezing the heart muscle so it can’t contract. Bundle up!
  • Don’t overdo it: There are so many winter sports–skiing, snowboarding, snowshoeing, tubing, and my personal favorite, ice skating! While many of these activities are wonderful ways to get exercise, they can do more harm than good. Since your heart is already strained by the chilly temperature, it is easy to overexert yourself and inadvertently trigger dangerous arrhythmias, arterial spasms, and consequent cardiac ischemia. Be careful!
  • Follow the rules: The holidays present lots of temptations and distractions. It’s easy to get caught up in the bustle and forget to take your meds, or skip your workout, or accidentally eat that thing you’re banned from. Don’t! Set reminders for yourself on your phone, find a buddy to hold you accountable, put up sticky notes, whatever–as long as you’re following doctor’s orders. They really do know best!
  • Take precautions: At Christmas, we exchange germs as well as gifts. The flu is awful for everyone, but it can be especially harmful to those with heart disease. Ask your cardiologist if you’re healthy enough for a flu shot. If you are not, stay away from sick people and wash your hands frequently in order to avoid contracting the influenza virus. You should also inform your cardiologist of planned air travel and intended alcohol consumption, as they can respectively increase the risk of blood clots and mimic feelings of warmth. If you do fly or drink, take the necessary precautions like blood thinners and extra coats. It is better to be safe than sorry!
  • Minimize stress: With family reunions, Christmas shopping, and airport lines, the holidays can take an emotional toll on us as well. Emotional stress causes physical stress, notably a raise in heart rate and blood pressure due to adrenaline release. Severe emotions including stress can trigger chest pain (stable angina), palpitations, and ‘broken heart syndrome’, a type of cardiomyopathy where part of the heart enlarges temporarily; a heart attack, stroke, or cardiac arrest could result. Deal with stress immediately, or you may become reliant on maladaptive coping mechanisms such as alcoholism, drug addiction, and/or eating disorders, all of which will further damage your heart.
  • Be aware: Take time to check in with yourself. Register how you’re feeling and act accordingly. If snow shovelling’s got you tired, take a break. If your family won’t bug off, get some alone time and breathe. If you’re cold, put on some gloves. If you’re feeling a bit peckish, eat a festive snack. If you experience chest pain or any other symptoms of a heart attack, call 911 immediately.

Thank you for reading! Have a happy and healthy holidays!

World Heart Day

Did you know that heart disease is the leading cause of death globally, killing an appalling 17.5 million people a year? Did you know that every forty seconds one person in America will have a heart attack? Did you know that 657 people in the United Kingdom will have a stroke today? Did you know that over 25% of Australian men suffer from hypertension? Did you know that heart disease costs the Canadian economy over $20.9 billion annually? Did you know that a quarter of all deaths in India can be attributed to cardiovascular disease? Did you know that heart disease takes twice as many lives as cancer in Malaysia? Did you know that over half the Mexican population is at risk for heart disease? Did you know that 278,933 Russian males died of coronary heart disease in 2009? Did you know that 26 million individuals suffer from heart failure? Did you know that 1 in 100 babies is born with a congenital heart defect? Did you know that 42 million women worldwide have a heart condition? Did you know that 98% of people do not survive out of hospital cardiac arrests? Did you know that things are only getting worse?

Heart disease is on rise. There has been a 60 million to 1 billion person increase in cases of uncontrolled hypertension between 1980 and the present. 1 in 10 school aged children are now overweight. 7% of the world smokes cigarettes. 23% of adults do not get the recommended amount of physical activity. Diabetes has increased in many countries by 50% in the past ten years. These risk factors, combined with the aging population, urbanisation, and inadequate prevention, are leading to a cardiovascular epidemic. By 2030, heart disease will have an annual death toll 24 million as well as a global economic burden of $1044 billion. These statistics are terrifying, and it is time we start taking heart disease seriously.

So ask yourself, are you at risk? Is your weight healthy? Do you follow your national heart association’s recommended exercise guidelines? Are you a non-smoker who drinks less then 14 units of alcohol weekly? Is your cholesterol below 200 mg/dL? Is your blood pressure 120/80 or lower? Are your electrolytes and blood sugar within the normal ranges? If you answered no to any of these questions, you are, indeed, at risk. Go see a cardiologist as soon as possible. You should also schedule an appointment immediately if you experience any of the following: chest pain (angina) or discomfort, palpitations, shortness of breath, arm/jaw/stomach pain, any cardiac arrhythmia, fatigue, nausea, and/or sweating. It is better to be safe than sorry.

Please, please be heart smart this World Heart Day. Know your numbers, get heart checked, and commit to a healthy lifestyle. Protect yourself and those you love. I know you may think you’re invincible, but heart disease can happen to anyone; don’t let it be you. Thank you so much for reading, and I hope you have a happy, healthy World Heart Day!

Cupcakes-&-Cardiology-Simran-Frontain-73

Rebirthday

I died on August 29th of last year. My heart stopped, and anorexia killed me. I was technically dead for three minutes.The doctors didn’t think I would make it. I was too far gone. The defibrillators weren’t working; my heart was too damaged; I would never recover from anorexia. Why bother trying? They called my cardiologist to tell her patient had died; she told them to try one more time.

They did, and that’s when the miracle happened. That’s when my heart started beating again; that’s when my lungs started breathing again. That’s when I opened my eyes; that’s when I learned to see. There were sparkles on the ceiling and jewel-drops in my eyes. There was a buzzing in my ears and a million voices in my head; I could hear them all clearly, and they were telling me the truth–the cold, hard, cement-stairwell truth: They told me I couldn’t go on like this; they told me I had to recover. 

And they were right; I knew they were. I couldn’t go on like this, and I didn’t want to. I had to make a change; I had to do this once and for all; I had to recover. 

And so on August 29th, 2016, after ten long years, I finally began my recovery journey. I sought the help of a dietician, psychologist, cardiologist, gastroenterologist, psychiatrist, general practitioner, and liver specialist. I underwent extensive physical and psychological therapy. I gained thirty-eight pounds. I got in touch with my emotions. I learned to eat and exercise in moderation. I found freedom with food and within myself. I broke away from anorexia, and I came back to life.

I was reborn on August 29th of last year. My heart started, and I beat anorexia. I’ve been alive for approximately 525,600 minutes. I survived. The doctors saved me; my heart conditions are now managed with medications; I am recovering from anorexia. Who would’ve thought? I made it out alive, and you can, too. 

It Won’t Happen to Me

It won’t happen to me: That has been an overarching theme in and out of my recovery. I’m a smart girl; I did my reading. I knew anorexia had its consequences; I just refused to acknowledge them. Hair loss, muscle weakness, dry skin, fatigue, osteoporosis, amenorrhea, organ failure, death. Whatever. It wouldn’t happen to me.

It can. It would. It did.

Let me tell you about August 3rd, 2016: Light rain dribbled from the sky, and there was slight, dull ache in my chest. Thinking nothing of it, I got up, put on my favorite red lipstick, and popped three diet pills. My favorite scholar was lecturing on Shakespearean sexual suicides today, and I wanted to get to the hall early to tell him what I thought of Cleopatra’s death, how I read it as an extended enactment of the Renaissance ‘die pun’. I sped down the Selwyn stairs so quickly that I ran out of breath. It must’ve been the running that caused me to feel a little ill. No, I’d been sick earlier, too, right when I’d woken up. The pills, perhaps? A bout of violent vomiting truncated my contemplations.

The pain in my chest was worse now, heavier, and I was dizzy, so dizzy that the world spun around me and lights on passing cars danced like fireflies. It felt like someone was squeezing my left arm. I couldn’t breathe. I practically fell onto the ledge in front of the college, clutching at my chest with tingy, claw-like hands. A sensible passerby must’ve called the British equivalent of 911 (999?), because the next thing I remember was screeching down the rainy roads in a screaming ambulance.

I woke up–if that’s the right phrase?–with my face pressed into a green white tile floor. I turned my head a little to look around; I saw chairs, and couches, and a vending machine. There were legs, too, sneakers and swishing pants, voices and people, wheelchairs and carts. ‘Do you have an emergency contact?’ I heard someone say. Did I? Was she talking to me?

Hands grabbed my feet and my shoulders, sore, soared off the floor. I found myself sitting up, back against a bendy chair. I was confused. Why were we moving? Where we going, gliding and sliding, sliding and gliding? Or were we? Was I imagining this, dreaming, nightmare-ing? I tried to pinch myself, but my arm wouldn’t budge.

Wrinkled white paper crinkled underneath brittle bones as they dropped me into the hospital holding bed. Nurses–well, I assume they were nurses?– started sticking things on me, red and white circles with wild, winding wires. I could see a sea of them, all over me like some horrible kind of rash. I wondered what they were. No, I didn’t want to know; I didn’t want to have to know, if you know what I mean?

A woman in blue told me to stay very still. They were going to do an EKG now, and I had to stay very still. But what was an EKG? Would it hurt? Did they have to take any blood? Is that what the circles were for? Hadn’t my psychiatrist wanted me to get one of these a while ago? I had so many questions–and so little breath to ask them.

A whirring, a tapping, a scratching. The printer in the back of the room spat and choked, gagging on a scroll. There was a wrenching, ripping sound as someone broke it open, tearing out its contents. With furrowed caterpillar brows, the printer surgeon examined his specimen. He handed it to the woman in blue who nodded and left the room, muttering something about something called an echo.

‘Printer problem.’ Someone said, stomping on the sludgy silence.

‘Yeah.’ An awkward laugh, a sigh that filled the room. ‘Must be. This can’t be right. That wouldn’t happen to her.’

It can. It would. It did.

The woman in blue returned with cart. ‘We’re going to do an echo now’ she informed me, as if I had some clue what that was. Strangers stripped me, black scissors bisecting a brassiere back. Folds fell to the floor and like a ragdoll I flopped forwards, arms contorted backwards, purposefully pulled into a hospital gown. Cold hands nudged my shoulders into a sinking pillow, and suddenly something chilly crept across my chest. Blue goo, lots of it, glittered like snow drifts under a fluorescent sun, and a probe skated over me, making my heart beat loud, loud over the hospital beeps.

‘Okay.’ Voices whispered. ‘Okay.’ The word bounced off the whitewashed walls, fleeing the room, fleeing like a mouse trapped a hungry snake’s cage. ‘Okay.’ They all looked at each other; I could feel the fear in their eyes.

‘You tell her.’ They said, speaking all at once. ‘No you, no you.’

Tell me? Tell me what?

Doors slammed, footsteps hammered, and faces leaned towards mine. I saw a mouth move. A man said something, something no one should have to hear. ‘You suffered,’ he informed me, looking down at the stack of papers one more time. ‘You suffered an acute electrolyte-imbalance-induced myocardial infarction.’

‘I what? A what?’

‘You had a heart attack.’

‘A what?’

‘A heart attack.’

A heart attack? No, that was impossible. Only old, fat men had heart attacks. It wouldn’t happen to me.

It can. It would. It did.

I had a heart attack that day, and I’m glad I did. Yes, I’m glad I had a heart attack. It almost killed me, but it saved my life. It was a wake up call, a slap in the face, a red flag in the neverending haze. It forced me realize what I couldn’t on my own: I am not immortal; I am not invincible; I am not immune. It could happen to me–and it did.